This transcript of the discussion has been edited for clarity and length.
We live in a world of ratings and reviews. The general public seems to grade us in real time on our performance as professionals. Some are uncomfortable with our Yelp culture. Fair enough. But the more open and self-assured of us use reviews to improve and to hone healthcare delivery. Let’s talk about how to increase patients’ willingness to recommend you, next on SoundPractice.
Mike Sacopulos: How do the issues and metrics differ when trying to increase recommendations for individual healthcare providers versus entire healthcare systems?
Susan Baker: They absolutely are different, and the question I urge people to ask themselves is: what is your goal in increasing patients’ willingness to recommend? For a Chief Experience Officer of a health system, that person’s goal might be to increase scores for public reporting. For a Chief Financial Officer, it might be to increase revenue that comes from higher HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) or CAHPS (Consumer Assessment of Healthcare Providers and Systems) scores. For someone interested in attracting new patients to an organization or practice, they may be more interested in Google reviews or reviews posted on social media.
Because the approaches are slightly different, I think it’s important to decide your focus. Some patients will gladly complete a 30-plus question HCAHPS survey and post about you positively on social media. But other people are going to choose based on the request you make of them.
Sacopulos: Consistency appears to be crucial for patient experience. How can healthcare organizations increase consistency?
Baker: You’re absolutely right about the importance of a consistent experience. I like to use the example of Durgin Park Restaurant, where I grew up near Boston. Everyone had to experience it at least once because of the word-of-mouth reputation. You expected rude hostesses and servers who would treat you horribly throughout the meal — and that was the promise created by friends who had already dined there. If your server wasn’t surly enough, you actually left disappointed.
Just like patrons of Durgin Park, patients expect the experience to match the rhetoric. The extent to which an individual’s healthcare experience matches their expectations influences their willingness to recommend a healthcare clinician or organization. But instead of surly servers, patients expect healthcare professionals to be kind, patient, compassionate, and empathetic.
The key to consistency is identifying or establishing highly visible behaviors that are important to patients — things like bedside shift reports or updating whiteboards daily. Your best opportunities for consistency can often be found in HCAHPS or other CAHPS survey results. Where an organization scores high is where consistency already exists, so you capitalize on those practices.
For areas needing improvement, you want to define for patients how you deliver on key concepts. For example, every survey asks “Were you treated with dignity and respect?” Respect is critically important to everyone, but we define it differently. I created a poster that says: “We want you to feel respected during your visit with us. To show respect for you: 1) We will sit down for part of the visit with you; 2) We will not ask questions while looking at the computer screen; 3) We will not interrupt you; and 4) We will ask ‘Is there anything else you would like to tell me?’ at least once during your visit.”
The most consistent application of behaviors occurs when the definitions are visible to both the person providing care and the person receiving care.
Sacopulos: How can practitioners identify and respond to individual patient preferences?
Baker: People value experiences in which their unique preferences are identified and respected. One of the easiest ways to identify preference is simply to give a choice. Healthcare was traditionally an order-giving setting, but there’s a subtle yet important difference between “Take a seat.” and “Would you like to have a seat?”
For organizations that want to be deeply serious about patient preferences, I recommend tapping into the expertise of their birthing center teams. Birth plans have been widely used for 30 to 40 years, and birthing center teams are experts in identifying and respecting differences.
Now, respecting preferences doesn’t mean honoring all preferences — we can’t always do that. Patients sometimes want medications that conflict with more important medications they’re taking, or we don’t have appointments at specific requested times. But acknowledging the preference can make all the difference.
I’ll give a personal example. I travel frequently and learned everything about the Ford Taurus because that’s what my car rental agency had most in their fleet. It would be unrealistic to expect they’d always have that car available. The savvy rental agent would say, “Mrs. Baker, we know you like the Ford Taurus. We don’t have one today, but we’ve chosen the one closest to it.”
I’m not getting what I want, but the acknowledgment of my preference gets us halfway there. It’s the same thing a registrar would say: “Mr. Ackman, I know you like early morning appointments. We don’t have one as soon as your physician needs to see you. Would it be possible for you to do a midday appointment any day next week?”
Sacopulos: What are some effective ways to build patient trust and confidence?
Baker: Stanford Hospital and Clinics placed emphasis on simple and quick ways to provide personalized care, resulting in significant increases in likelihood to recommend across all areas surveyed — emergency department, inpatient, ambulatory, cancer clinics, and their cancer center.
Dr. Winnacker, their chief of staff, described the techniques as “painfully obvious” but noted they hadn’t been applied consistently. These included: introduce yourself to everyone in the room; acknowledge any wait; convey that you know something about the patient’s history; ask for the reason for the patient’s visit — Dr. Winnacker said it was surprising how often the patient’s chief complaint differed from the physician’s understanding; express empathy; sit on the same level; use body language that implies interest rather than impatience; ask permission to do tests; include patients and family members in decisions about therapy; and ensure patients know the treatment plan.
That’s a list of about 10 behaviors they started applying consistently. My suggestion is that people start with four or five at most. We can create a great list of 25 patient-satisfying behaviors, but people can’t always demonstrate 25 behaviors in a visit, leading to inconsistency. I’d rather see a team do four things exceptionally well and be known for that, because reliability is critical for willingness to recommend.
Recommendations of healthcare professionals are pure gold for building trust and confidence, because insiders know the real story. When you see a testimonial by a clinician who was a patient, it’s highly influential.
Sacopulos: How can social media and online reviews increase patient loyalty and willingness to recommend?
Baker: If someone stopped you in a hallway and thanked or complimented you for something, you wouldn’t pass by without a word. Yet every day I see testimonials in social media that aren’t acknowledged, and that’s a crying shame.
If I’ve had a great experience and post a recommendation on social media, but see no comments on other posts, I’m less likely to take time crafting something meaningful because it seems to make no difference to the clinician or organization I feel positive about. On the other hand, when I see positive responses from the organization, that tells me what the previous poster said is true — this is a caring organization worth remembering.
There’s also an opportunity to create what I call “spread” with social media comments. Share HCAHPS comments strategically — always choose reviews that reflect where you’re most consistent and where people mention recommending you. When people say they’re going to recommend, that plants a seed for future recommendations.
Sacopulos: Do you think it’s appropriate to ask patients for reviews?
Baker: I think it’s critical to ask patients for reviews, but you want to think through your goal. If your goal is to increase HCAHPS scores, follow the CMS guidelines clearly spelled out on the CAHPS website.
I’ll share a story about my 92-year-old father, who would give up his life for his doctor — he loves his physician. When the patient survey came, I offered to help him fill it out given how much he thinks of his doctor. He said, “Oh, I never fill those out.” When I asked why, given my 30 years devoted to this field, he said, “Number one, no one reads them. Number two, no one’s ever asked me to fill it out.”
Having people feel comfortable asking for recommendations is key. In a discharge conversation, you could ask “What will you tell your family or friends about your stay with us?” When a patient expresses gratitude for a good clinical outcome, you could say, “What would you tell someone considering this procedure?”
For patient experience surveys, it’s very simple: “You may receive a patient experience survey after your visit with us. I would love to read your comments. Thank you for your time in giving us feedback.” No incentives, no penalties, no promises — just appreciation for their time.
Sacopulos: How would you involve team members in a willingness-to-recommend campaign?
Baker: First, ask team members who use social media to follow your account. Second, when a person is mentioned in a social media post, let them know and ask them to add a comment of thanks. Do the same when a team is recognized. Third, provide recognition for those whose names might not be remembered in surveys — like nursing assistants. I loved seeing New York-Presbyterian Cornell create Instagram posts that looked like newspaper columns titled “Best NAs [nursing assistants] in New York City” with comments by colleagues praising their work. This demonstrates teamwork, which is one of those Press Ganey drivers that makes patients feel “if people like each other and get along, they’re going to take better care of me.”
Memorial Sloan Kettering had a wonderful approach in their family surgical waiting area — a huge poster board with photos and names of all presurgical, surgical, and post-anesthesia care staff, even the chaplain. They provided comment tear-off cards so families could immediately recognize anyone who provided exceptional care.
Sacopulos: If you were mapping out a comprehensive strategy to increase patient willingness to recommend, what else would you include?
Baker: First, I’d look at website quality. There’s a clear connection between people being able to access information they need 24/7. Is there an updated, accurate FAQ section? Are there easy options for submitting testimonials?
Second, I’d seriously examine how you manage and minimize friction and service failures. Athena Health studied 70,000 survey responses and found that when patients estimated their wait time was five minutes or less, 82% said they would recommend the primary care physician. Those numbers dropped dramatically with longer waits — any wait longer than 45 minutes saw willingness to recommend drop to 47%.
Third, stay connected with retired associates and physicians. Retirees have more time to make recommendations, they’re still regarded as insiders, and will be asked for advice when medical services are needed. But they can quickly feel out of date without connection to new physicians or services.
Fourth, recognize those who recommend you. Compliment the person who has complimented you. On intake forms, ask “Who may we thank for recommending us to you?” — but always get the patient’s permission first.
Finally, demonstrate that feedback makes a difference. At Orthopedic Hospital of Wisconsin, they post: “Do you wonder if anyone reads your survey at OHOW? Our CEO personally reads each and every patient comment.” I love the idea of boards that say “You said... we did...” showing how organizations respond to feedback.
Sacopulos: You have a new book coming out on this topic. Can you tell us about that?
Baker: I’m in the third quarter of working on a book with lots of examples like the ones we’ve discussed today. I’m planning for the book to come out in January.